Maternal cocaine abuse and effect on the newborn

Cocaine has been increasingly available to a wider population of potential users in the United States. Information concerning possible effects of this agent on the fetus and newborn is lacking. We observed eight infants whose mother's gave a history of cocaine abuse and, in whom, results of a urine screen for cocaine were positive. We observed no evident symptomatology or signs of teratogenicity on these infants. Although this is encouraging, more studies, including Brazelton assessment, and long-term follow-up of infants born to cocaine-abusing mothers is necessary.     

Maternal substance abuse

The epidemic of substance abuse, which has swept through much of the world, has len behind a trail of devastated lives and families. Alcohol and substance abuse by women during pregnancy has also been reported to be widespread and can affect the unborn fetus with the potential for life-long disabilities. While the magnitude of the perinatal substance abuse has been the focus of much discussion in the West, the problem is greatly underestimated in other parts of the world. In this article, the author has focused on five highly-abused substances and explored the effects of the drugs on the fetus and the newborn. There is a constant need for evaluating the epidemiology and the consequences of perinatal substance abuse so that health programs can target measures to eliminate the preventable morbidity that results from this practice.     

Use of nalotone to to reverse narcotic respiratory depression in the newborn infant.

Twenty neonates whose mothers had received meperidine (1.0 to 1.5 mg/kg) intravenously within three hours of delivery were studied to determine the effectiveness of naloxone in reversing neonatal respiratory depression. The following measurements were carried out within 20 to 30 minutes after delivery: minute ventilation, end tidal CO2, and ventilatory response to CO2. These determinations were repeated after administration of either placebo or naloxone, 0.01 mg/kg intramuscularly. Minute ventilation and PAco were within a normal range before medication in both groups, but the slope of the CO2 response curve was decreased, indicating mild-to-moderate respiratory depression. After administration of placebo the test results did not change significantly. After administration of naloxone, VE increased significantly (P less than 0.05) and the slope of the CO2 response curve doubled (P less than 0.001). Naloxone effectively reverses narcotic depression of the respiratory center in the newborn infant.     

Maternal smoking and body composition of the newborn

The influence on neonatal anthropometry of maternal cigarette smoking in pregnancy was investigated in 933 parous women. Anthropometric growth parameters including skinfold measurements were studied in the newborns. After adjustment for maternal age, pre-pregnancy weight, height and pregnancy weight gain, smoking had a clear dose-dependent negative effect on all anthropometric characteristics in the infant. In contrast to the results obtained in other investigations, the reduced birth weight of the infants of smoking mothers was not found to be primarily due to a reduction in lean body mass; nor was fat deposition found to be reduced. Fetal anthropometry was also negatively affected in infants born to mothers who stopped smoking during pregnancy.     

Naloxone for narcotic exposed newborn infants: systematic review

BACKGROUND: Naloxone, a specific opiate antagonist, is available for the treatment of newborn infants with respiratory depression that may be due to transplacentally acquired opiates. AIMS: To determine if this treatment has any clinically important benefits, and whether there are any harmful effects. METHODS: Randomised controlled trials that compared naloxone with placebo or no drug for newborn infants with transplacental exposure to narcotics were systematically reviewed. The Cochrane Controlled Trials Register (CCTR; 2002, Issue 3), Medline (1966 to June 2002), and Embase (1988 to June 2002) were searched. Data were extracted, analysed, and synthesised using the standard methods of the Cochrane Neonatal Collaborative Review Group. RESULTS: Nine trials were found that fulfilled the specified inclusion criteria. Although there was evidence that naloxone increased alveolar ventilation, no data were found on the specified primary outcomes of this review: the need for assisted ventilation or admission to a neonatal unit. CONCLUSIONS: There is a need for a randomised controlled trial to determine if naloxone confers any clinically important benefits on newborn infants with respiratory depression that may be due to transplacentally acquired narcotic.     

Maternal active smoking and newborn body composition

Objective

Maternal smoking during pregnancy is associated with a reduction in birth size but very few studies have collated changes in neonatal anthropometry. Our aims were both to assess body composition differences by anthropometry between new-borns from smoking mothers and those from non-smoking mothers, and to show whether these differences affect proportional body mass distribution.

Methods

Caucasian mothers and their full term singleton new-borns (N = 1216) were selected during 2009. A structured questionnaire was completed regarding obstetric and demographic data, as well as tobacco consumption. Women were categorized, according to their smoking habits, into a non-smoking group (never smoked or stopped smoking prior to pregnancy) and a smoking group (smoked throughout pregnancy).

Results

22.1% of mothers smoked during pregnancy (median: 6 cigarettes/day, range: l–40). Smoking mothers were significantly younger than non-smoking mothers but there were no differences regarding other aspects which could affect infant weight. Infants from non-smoking mothers were heavier, longer, and body circumferences were all larger than those from smoking mothers (p < 0.001), but the Ponderal Index showed no statistical differences. Skinfold thicknesses were significantly lower in new-borns from smoking mothers but these differences were less evident than those from body size. Subcutaneous fat distribution did not show statistical differences between the two groups. After gestational age, to smoke during gestation is the second main determinant of birth weight.

Conclusions

Smoking during pregnancy involves a generalized reduction of most axiological parameters as a result of proportionate fetal growth impairment. In those infants born from mothers who smoked during gestation, neonatal lean body mass appears to be more affected than body fat, and distribution of subcutaneous fat is not different.     

Maternal cell microchimerism in newborn tissues

OBJECTIVES: On the basis of reports of maternal cells being detected in the umbilical cord blood of newborn infants, we tested the hypothesis that maternal cells can migrate out of the circulation into newborn tissues. STUDY DESIGN: We studied autopsy material from 4 newborn infants who never received a blood transfusion and died during the first week of life. The study subjects' diagnoses were trisomy 21 with nonimmune hydrops, 46, XY, 4q+ with multiple congenital anomalies, Potter syndrome, and congenital ichthyosis. Fluorescence in situ hybridization analysis with X and Y chromosome-specific probes was performed on sections of paraffin-embedded tissue, including liver, spleen, thymus, thyroid, and skin. RESULTS: Female cells, as defined by the presence of intact nuclei with two X chromosome signals, were detected in multiple tissue types from all 4 male neonates. The number of female cells varied from 3 to 45 per slide. CONCLUSIONS: Maternal cells enter the fetal circulation and are capable of migration to fetal and neonatal organs. This is of importance with regard to potential consequences of umbilical cord blood transplantation and postnatal development of autoimmune disease.     

Maternal blood pressure in pregnancy and newborn irritability

The neonatal period is being recognized as an important period for the development of patterns of interaction between mother and infant, and infant state has been shown to have a significant impact on mother-infant interactions. A major dimension of infant state, with implications for this interaction and for the development of later behaviour disorders, is the infant's irritability. Research with Navajo, Malay, Chinese and Tamil mothers and infants showed that normal variation in maternal blood pressure during pregnancy was related to newborn irritability as assessed with the Brazelton Scale. This relationship is discussed in terms of possible underlying mechanisms.     

Maternal responses to the sexual abuse of their children

To define categories of maternal response and determine their relationship to variable features of the abuse situation, a questionnaire was administered to mothers of 103 children returning for a routine 2- to 3-week follow-up of a sexual abuse episode. Three categories of response were identified: nonsupportive, supportive without emotional changes, and supportive with emotional changes. Nonsupportive mothers (n = 32) believed that the abuse complaint was a lie, a misunderstanding, or the child's fault. They rarely considered pressing charges or requested counseling. Supportive mothers (n = 71) believed that the child was telling the truth and that the assailant was primarily responsible. Anger, fear, anxiety, and guilt were commonly expressed. Thirty-nine of the supportive mothers reported behavior or mood changes including sleep, appetite, or somatic complaints and recurrent crying. Most were pressing charges (79%) and sought counseling for themselves (74%) and their children (82%). The 32 supportive mothers without behavior or mood changes also frequently pressed charges (88%) but sought counseling for themselves (6%) and the children (53%) less often (P less than .001). Individual personality and coping mechanisms may determine the maternal response. Maternal emotional responses do not appear to be related to variable features of the abuse situation but are significantly related to the approach to subsequent psychologic and legal issues.     

Maternal predictors of subcutaneous fat in the term newborn

AIM: To determine the relative influences of some maternal factors on skinfold thickness. The effects of age, parity, height, body mass index (BMI) and pregnancy weight gain (PWG) of the mother on the subscapular skinfold thickness (SST) of the newborn were estimated, and compared with their effects on birthweight (BW), crown-heel length (CHL) and head circumference (HC). METHODS: A sample of 13, 972 healthy, term singletons was selected at the Clamart Maternity Hospital (France). Stepwise regressions were used to determine the most predictive maternal factors for each parameter in the newborn. The respective effects of the mother's age and parity on each newborn dimension were tested by analysis of variance. RESULTS: The SST is a singular parameter, influenced by the mother's BMI and PWG, but not by her height. In contrast, the main predictor of BW, CHL and HC is the height of the mother, and to a lesser extent her PWG and BMI. Parity and maternal age have a smaller effect, except on SST, and essentially between the first and second pregnancies. CONCLUSION: These results clearly separate SST from other newborn dimensions. The skinfold thickness depends only on the nutritional status of the mother, while other dimensions are markedly influenced by the genetic background. This study is the first to demonstrate the singularity of skinfold thickness in newborn infants as a marker of the mother's nutritional status.     

Maternal depressive symptoms during pregnancy, and newborn irritability

Maternal depression is associated with a wide range of adverse outcomes for children, including poor mother-infant interactions at 3 months post-partum. The aim of this study is to determine whether maternal depressive symptoms during pregnancy are associated with neonatal neurobehavioral functioning, as measured by the Neurologic and Adaptive Capacity Scale. The study population consists of 1,123 mothers and their term infants who were participants in a larger study of maternal health and infant outcomes. Women were administered the Center for Epidemiologic Studies-Depression (CES-D) questionnaire for depressive symptoms during their pregnancy. Their infants were subsequently assessed by a pediatrician blind to their CES-D scores. The CES-D score was associated with unconsolability and excessive crying (p less than 0.01). The higher the mother's CES-D score, the more likely it was that the infant would be unconsolable or cry excessively. Mothers with CES-D scores at the 90th percentile were 2.6 times more likely to have unconsolable newborns, compared with women with CES-D scores at the 10th percentile (95% C.I. = 1.54, 4.23). When potentially confounding variables, such as cigarette smoking, alcohol, marijuana, and cocaine use, poor weight gain, income, birth weight, and other drug use, were controlled, the relationship between CES-D score and newborn unconsolability and excessive crying remain unchanged. The results of this study suggest that the relationship between early childhood problems and maternal depressive symptoms may be part of a sequence that starts with depressive symptoms during pregnancy.     

Maternal age and other predictors of newborn blood pressure

OBJECTIVE: To investigate perinatal predictors of newborn blood pressure. STUDY DESIGN: Among 1059 mothers and their newborn infants participating in Project Viva, a US cohort study of pregnant women and their offspring, we obtained five systolic blood pressure readings on a single occasion in the first few days of life. Using multivariate linear regression models, we examined the extent to which maternal age and other pre- and perinatal factors predicted newborn blood pressure level. RESULTS: Mean (SD) maternal age was 32.0 (5.2) years, and mean (SD) newborn systolic blood pressure was 72.6 (9.0) mm Hg. A multivariate model showed that for each 5-year increase in maternal age, newborn systolic blood pressure was 0.8 mm Hg higher (95% CI, 0.2, 1.4). In addition to maternal age, independent predictors of newborn blood pressure included maternal third trimester blood pressure (0.9 mm Hg [95% CI, 0.2, 1.6] for each increment in maternal blood pressure); infant age at which we measured blood pressure (2.4 mm Hg [95% CI 1.7, 3.0] for each additional day of life); and birth weight (2.9 mm Hg [95% CI, 1.6, 4.2] per kg). CONCLUSIONS: Higher maternal age, maternal blood pressure, and birth weight were associated with higher newborn systolic blood pressure. Whereas blood pressure later in childhood predicts adult hypertension and its consequences, newborn blood pressure may represent different phenomena, such as pre- and perinatal influences on cardiac structure and function.     

Maternal attitude and practices in initiation of newborn feeding

The present study highlights the need for due emphasis on initiation of breast feeding of newborn infants over other traditional prelacteal newborn feeds. Knowledge, attitudes and newborn feeding practices amongst 702 mothers with urban background was recorded. Though 83.5% of mothers had attended the antenatal clinics, only 13.24% had been given breast feeding advice at the antenatal clinics. It is a cause of concern that only 26.35% had initiated the feeding by breast milk and only 16% had given colostrum. A large number of newborns were fed with finger tips and other unhygienic methods. However, most (95.01%) mothers had started breast feeding their newborns before discharge from hospital.